

<div class="layui-form" lay-filter="layuiadmin-form-comment" id="layuiadmin-form-comment">

  

  <div class="layui-form-item">
    <label class="layui-form-label">省</label>
    <div class="layui-input-inline">
      <script type="text/html" template>
        <input type="text" name="province" value="{{ d.params.tags || '' }}" lay-verify="required" placeholder="请输入..." autocomplete="off" class="layui-input">
      </script>
    </div>
  </div>
  <div class="layui-form-item">
    <label class="layui-form-label">市</label>
    <div class="layui-input-inline">
      <script type="text/html" template>
        <input type="text" name="city" value="{{ d.params.tags || '' }}" lay-verify="required" placeholder="请输入..." autocomplete="off" class="layui-input">
      </script>
    </div>
  </div>
  <div class="layui-form-item">
    <label class="layui-form-label">详细地址</label>
    <div class="layui-input-inline">
      <script type="text/html" template>
        <textarea name="detail" lay-verify="required" style="width: 400px; height: 150px;" autocomplete="off" class="layui-textarea">
            {{ d.params.content || '' }}
          </textarea>
      </script>
    </div>
  </div>
  <div class="layui-form-item">
    <label class="layui-form-label">姓名</label>
    <div class="layui-input-inline">
      <script type="text/html" template>
        <input type="text" name="name" value="{{ d.params.tags || '' }}" lay-verify="required" placeholder="请输入..." autocomplete="off" class="layui-input">
      </script>
    </div>
  </div>
  <div class="layui-form-item">
    <label class="layui-form-label">手机号</label>
    <div class="layui-input-inline">
      <script type="text/html" template>
        <input type="text" name="phone" value="{{ d.params.tags || '' }}" lay-verify="required" placeholder="请输入..." autocomplete="off" class="layui-input">
      </script>
    </div>
  </div>
  
  
  <div class="layui-form-item">
    <label class="layui-form-label"></label>
    <div class="layui-input-inline">
      <input type="button" lay-submit lay-filter="layuiadmin-app-com-submit" value="确认" class="layui-btn">
    </div>
  </div>
</div>